Risk Factors Analysis And Prediction Of Postoperative Pancreatic Fistula After Laparoscopic Pancreaticoduodenectomy

Objective:Based on 100 cases of laparoscopic pancreaticoduodenectomy perioperative indicators,we want to analysis of risk factors for postoperative pancreatic fistula,explore the clinical significance of risk factors,set up prediction model,and provide guidance for clinical prevention and treatment of postoperative pancreatic fistula.Methods:A retrospective analysis of the perioperative data of 100 patients undergoing laparoscopic pancreaticoduodenectomy performed in the Department of Hepatobiliarypancreatic Surgery of the first hospital of Jilin University from January 2018 to October 2018.The above data are divided into preoperative data,intraoperative data,postoperative data,and pathological data.The data were collected by Excel2007.Statistical analysis use SPSS22.0 software.The measurement data are expressed by (?)±s or M(Q25?Q75).Comparing the two groups of measurement data,the t-test was used for the normal distribution,rank sum test was used for non-normal distribution.Counting data are expressed by frequency and rate,chi-square test was used for comparison,and nonparametric test was used for comparison of ordered grade data.Logistic regression analysis is used for multivariate analysis and ROC curve analysis is used for prediction analysis.P <0.05 is considered statistically significant.Results:The results of single factor analysis,multi-factor analysis and ROC prediction for 100 patients were as follows:1.Single factor analysis found that patients with pancreatic fistula and non-pancreatic fistula between BMI(t = 2.218,P = 0.029),CA199(Z = 1.973,P = 0.048),the pancreas texture(chi-square = 8.562,P = 0.003),pancreatic duct diameter(chi-square = 9.024,P = 0.003),operation time(Z = 2.010,P = 0.044),intraoperative blood loss(Z = 2.314,P = 0.021),tumor location(chi-square = 5.391,P = 0.020),the difference was statistically significant,may be associated with postoperative pancreatic fistula 2.Further Logistic regression analysis revealed that the long operation time(OR: 1.059,95%ci:1.015?1.106,P= 0.009),soft pancreatic texture(OR:0.074,95%ci :0.006?0.951,P= 0.046),pancreatic duct diameter ?3mm(OR:0.010,95%ci :0.000?0.631,P= 0.030)and non-pancreatic tumors(OR:78.831,95%ci: 1.378-4509.928,P= 0.034)were independent risk factors for postoperative pancreatic fistula.3.ROC analysis showed that the prediction effect of pancreatic duct diameter was the best among single factors(AUC=0.731),the prediction effect of two-factor operation time + pancreatic duct diameter was the best(AUC=0.839),and the prediction effect of three-factor operation time + pancreatic duct diameter + tumor location was the best(AUC=0.930).When combined with the four factors,the prediction effect was up to(AUC=0.952).4.The effect of postoperative pancreatic fistula on clinical prognosis was analyzed,and it was found that the time of abdominal drainage tube removal,postoperative complications,abdominal infection rate,reoperation rate,postoperative hospitalization time and hospitalization cost in patients with pancreatic fistula were all higher than those without pancreatic fistula,and the above factors were statistically significant(P<0.05).Conclusion:1.BMI,CA199,operative time,intraoperative blood loss,pancreatic texture,pancreatic duct diameter,and tumor location may be correlated with pancreatic fistula after LPD.Among them,long operative time,soft pancreatic texture,narrow pancreatic duct diameter and non-pancreatic tumors are independent risk factors for postoperative pancreatic fistula.2.Through single factor or multi-factor combined prediction analysis,it was found that the operative time,pancreatic texture,pancreatic duct diameter and tumor location had good predictive value for pancreatic fistula after LPD.3.Postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy is closely related to the prognosis of patients.Postoperative pancreatic fistula will prolong the time of abdominal drainage tube extraction,increase the rate of reoperation,the incidence of individual complications and the probability of abdominal infection,and at the same time,prolong the postoperative hospitalization time and increase the hospitalization cost.